Photo Credit: Design Cells
Richter transformation (RT), the progression of chronic lymphocytic leukemia (CLL) or small lymphocytic lymphoma (SLL) to aggressive lymphoma, remains a clinical challenge with a poor prognosis. A recent study from ASH 2024 examined the clinical features and outcomes of RT in British Columbia, comparing two eras: the chemoimmunotherapy (CIT) era (pre-2016) and the novel agents (NA) era (post-2016).
From 2000 to 2023, 207 patients with RT were analyzed. Most (72%) were diagnosed with diffuse large B-cell lymphoma, with a median age of 71 years and a median time of five years from CLL/SLL diagnosis to RT. At presentation, patients often had advanced disease features such as poor performance status (61% with ECOG 2-4), elevated LDH (74%), and bulky tumors (27%). The majority received R-CHOP-like regimens, and 17% did not receive systemic therapy due to frailty. Median progression-free survival (PFS) was 5.8 months, and median overall survival (OS) was 9.8 months. Patients treated with systemic therapy had better outcomes, with a median OS of 13 months. However, survival rates remained low, with a two-year OS of only 31%.
The transition to the NA era saw notable shifts in patient characteristics and treatment histories. Patients were older, had poorer performance status, and a longer interval between CLL/SLL diagnosis and RT. Use of novel agents such as BTK and BCL2 inhibitors was higher in the NA era. Despite these changes, outcomes did not significantly improve, and a trend toward shorter OS in the NA era (6.8 vs. 11.3 months) was observed. Prior CLL/SLL treatment significantly worsened outcomes, with untreated patients showing a markedly better median OS of 42.7 months compared to 6.1 months for those with prior therapy.
Per the authors, this study highlighted the persistent unmet need for more effective and tolerable RT treatments. Although novel agents have altered the treatment landscape of CLL/SLL, their impact on RT outcomes remains unclear. Patients continue to present with advanced disease features and poor prognoses, underscoring the urgency for innovative therapeutic strategies tailored to this high-risk population.
